Day 5: Eating for Diabetes: The Truth About Controlling Blood Glucose

Today we're wrapping up our series with Cyrus Khambatta! Thank you Cyrus!

Day 5: Eating for Diabetes: The Truth About Controlling Blood Glucose

There is a lot of confusion about what diets are best for diabetics.  In today’s lesson, I’ll share with you 6 principles about eating for diabetes that are backed by scientific research, and have been shown in human studies to reverse the effects of insulin resistance.

To Fat or Not to Fat?  That is the Question

The biggest debate in the nutrition world in our generation is whether eating a low fat diet or high fat diet is better for you.  Over 20 years ago, a low fat diet was considered the healthiest diet, because high fat foods were thought to elevate cholesterol and triglyceride levels in the blood, contributing to heart disease.  In the 1990’s along came Dr. Atkins, who argued that fat was not the enemy, an instead vilified carbohydrates.  He reasoned that excess carbohydrates are converted to fat and stored as fat, contributing to conditions like obesity and type 2 diabetes.  In today’s nutrition world, the paleo diet has taken center stage.  Proponents of this diet argue that eating similarly to our ancestors – a high intake of unprocessed foods and a complete elimination of refined products - is the most evolutionary accurate diet for humans, and is the diet that is best suited for the inner workings of our digestive systems. 

It seems like every 10 years or so, a new breed of dietary tribalism takes hold, changing public opinion on the “healthiest” diet for human consumption.  More importantly, the opinion about whether fat is “healthy” or “unhealthy” changes about once a decade.  So what’s the answer?  Is fat good or is fat bad?  As a diabetic, should you be eating fat or not eating fat?  Should you be eating carbohydrates or not eating carbohydrates?

Let’s go back to what we talked about on day 2.  We said that excess fat has a nasty way of being stored everywhere in your body.  It is stored inside of your muscle tissue.  It is stored in your liver.  It is stored in your heart.  It is stored in fat tissue.  It is stored in your pancreas.  It is stored in your intestine. 

Excess fat is stored in all tissues in the human body, including those that are not designed to store fat. 

Ectopic Fat Accumulation

Take a look at this picture.  This is a highly magnified view of a fatty liver that has accumulated excess fatty acids over time.  The fatty acids are stained in purple, and are located in droplets within liver cells.  The fact of the matter is that these purple droplets are not supposed to be as large or as numerous as they are.  This fatty liver is suffering from ectopic fat accumulation, a term that means “the storage of fat in tissues that are not designed to store fat.” 

We also learned on day 2 that excess fat storage impairs the action of insulin.  In simpler words:

The accumulation of fat  in tissues that are not designed to store fat sets the stage for insulin resistance.

So what causes ectopic fat accumulation?  Will eating fat cause this problem?  Will eating too many carbohydrates cause this problem?  What about large amounts of protein, will that cause insulin resistance? 

Glucose and Fat: The Battle for World Domination

Fatty acids, glucose and protein (amino acids) all compete for entry into body tissues.  Fatty acids and glucose are either burned for energy immediately, or stored and burned for energy later.  Protein is also burned for energy, although amino acids (the building blocks of protein) are often distributed around the cell to be used as part of the cellular infrastructure. 

When fatty acids and glucose are both present in the bloodstream following a meal, they seek entrance into cells all throughout the body.  In an ideal world, both glucose and fatty acids would be vacuumed and used equally.  But in reality, glucose and fatty acids compete with each other for entry into cells, and one of the two wins.  Every time.  Can you guess which one?

Fatty acids win.

Fatty acids win because they can gain entry into the cell faster than glucose.  And guess what that means?  It means that glucose stays in the bloodstream instead of being vacuumed into cells like we want.  And when glucose stays in the bloodstream, high blood sugar ensues.

The truth of the matter is that even a small amount of fat can have a large effect on blood sugar control.  It only takes a small serving of fat to outcompete glucose, gaining entry into tissues faster. 

On average, a meal containing 100 grams of carbohydrate and 0 grams of fat can be cleared from the bloodstream in 3 hours in an insulin sensitive individual.  The same meal containing 100 grams of carbohydrate, when eaten together with 15 grams of fat may take up to 8 hours to clear from the bloodstream.  The presence of only 15 grams of fat results in high blood sugar lasting up to 5 hours longer than normal. 

Your mission as a diabetic health machine is to give glucose a fighting chance.  Allow glucose the ability to enter body tissues by removing fatty acids - the one obstacle in it’s path.   

Glucose is Your Body’s Preferred Fuel Source

Make no mistake, every tissue in your body is designed to run on glucose.  Unfortunately, we have been told many times over that carbohydrates are the enemy.  We have been told that carbohydrates turn to fat.  We have been told that carbohydrates make you overweight. 

We must make a distinction between REAL and FAKE carbohydrates.

What are FAKE Carbohydrates?

FAKE carbohydrates are foods that are high in carbohydrate yet low in nutrients.  FAKE carbohydrates are the products of a manufacturing process.  FAKE carbohydrates often have additives, in order to replace the nutrients that were lost through processing.  FAKE carbohydrates have a long list of ingredients, most of which are hard to pronounce. 

FAKE carbohydrates have names like High Fructose Corn Syrup (HFCS), sugar, cane sugar, organic cane sugar, molasses, aspartame, splenda, etc.

FAKE carbohydrates increase insulin resistance mainly by increasing the amount of fat stored in the liver and abdomen^1–4. 

Refined (FAKE) carbohydrates are found everywhere in the grocery store.  FAKE carbohydrates are generally packaged, bottled, coated with sprinkles and contain a long list of difficult-to-pronounce ingredients.  As a general rule, if you don’t think that your great great grandmother would recognize the food, it’s probably not something you want to be putting into your body.  Foods that were sold only a hundred years ago were less refined, resulting in a higher consumption of perishable, REAL food. 

What are REAL Carbohydrates?

REAL carbohydrates come in the form of fruits and vegetables, and are generally perishable.  They are foods that you would find if you were walking through in nature, and foods that require little to no preparation.  They contain a combination of complex and simple sugars, and are designed to taste sweet and break apart into glucose molecules for use by all major tissues in your body.

REAL carbohydrates are fruits, vegetables, leafy greens, and legumes.  REAL carbohydrates tend to have a short shelf-life because they are generally fresh fruits and vegetables, containing a large quantity of water, fiber, vitamins, minerals and antioxidants. 

If you still need more convincing, take a look at the references below.  This is only a short list of scientific articles that explain the effect of fatty acids on insulin action.  They contain a bit of technical jargon, but explain how insulin resistance can be minimized simply by reducing fat intake^5–13. 

Hungry for More?  Read These References

1.            Stanhope, K. L. et al. Consumption of Fructose and High Fructose Corn Syrup Increase Postprandial Triglycerides, LDL-Cholesterol, and Apolipoprotein-B in Young Men and Women. J. Clin. Endocrinol. Metab. 96, E1596–E1605 (2011).

2.            Stanhope, K. L., Schwarz, J.-M. & Havel, P. J. Adverse metabolic effects of dietary fructose: results from the recent epidemiological, clinical, and mechanistic studies. Curr. Opin. Lipidol. 24, 198–206 (2013).

3.            Stanhope, K. L. et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J. Clin. Invest. 119, 1322–1334 (2009).

4.            Goran, M. I. et al. The obesogenic effect of high fructose exposure during early development. Nat. Rev. Endocrinol. (2013). doi:10.1038/nrendo.2013.108

5.            Delarue, J. & Magnan, C. Free fatty acids and insulin resistance. Curr. Opin. Clin. Nutr. Metab. Care 10, 142–148 (2007).

6.            Wang, P.-Y., Kaneko, T., Wang, Y., Tawata, M. & Sato, A. Impairment of Glucose Tolerance in Normal Adults Following a Lowered Carbohydrate Intake. Tohoku J. Exp. Med. 189, 59–70 (1999).

7.            Xiao, C., Giacca, A., Carpentier, A. & Lewis, G. F. Differential effects of monounsaturated, polyunsaturated and saturated fat ingestion on glucose-stimulated insulin secretion, sensitivity and clearance in overweight and obese, non-diabetic humans. Diabetologia 49, 1371–1379 (2006).

8.            Wolpert, H. A., Atakov-Castillo, A., Smith, S. A. & Steil, G. M. Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes Implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Dia Care 36, 810–816 (2013).

9.            Pańkowska, E., Błazik, M. & Groele, L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol. Ther. 14, 16–22 (2012).

10.          Gormsen, L. C., Nielsen, C., Jessen, N., Jørgensen, J. O. L. & Møller, N. Time-course effects of physiological free fatty acid surges on insulin sensitivity in humans. Acta Physiol. Oxf. Engl. 201, 349–356 (2011).

11.          Boden, G. Fatty acid-induced inflammation and insulin resistance in skeletal muscle and liver. Curr. Diab. Rep. 6, 177–181 (2006).

12.          Hession, M., Rolland, C., Kulkarni, U., Wise, A. & Broom, J. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes. Rev. 10, 36–50 (2009).

13.          Rosenfalck, A. M., Almdal, T., Viggers, L., Madsbad, S. & Hilsted, J. A low-fat diet improves peripheral insulin sensitivity in patients with Type 1 diabetes. Diabet. Med. J. Br. Diabet. Assoc. 23, 384–392 (2006).